.■
Washington, D. C.
'*&&'
AS
INAUGURAL DISSERTATION
ON T H B
SMALL-POX:
Submitted to the Examination of
The Rev. JOHN EWING, S. S. T. P.' Provost;
The TRUSTEES and MEDICAL PROFESSORS
O F
The University of Pennsylvania,
IN ORDER TO OBTAIN THE DEGREE OF
DOCTOR of MEDICINE,
On the tenth Day of May, A. D. 1792.
By NINIAN MAGRUDER,
Of Montgomery County, Maryland.
s~~ —■-—"^
PRINTED BY ZACHARIAH POULSON, JUNIOR, N0'30, NORTH^-Vi. '
FOURTH-STREET, NEAR THE UNIVERSITY.
M D C C SCII.
T O
WILLIAM SHIPPEN, jun. M. D.
AND
CASPAR WIS TAR, M. D.
Profeffors of Anatomy, Surgery and Midwifery;
BENJAMIN RUSH, M. D.
Profeffor of the Inftitutes and Clinical Medicine;
ADAM KUHN, M. D.
Profeffor of the Theory and Praclice of Medicine;
JAMES HUTCHINSON, M. D.
Profejfor of Chemtftry;
AND
SAMUEL POWEL GRIFFITTS, M. D.
Profejfor of the Materia Medica and Pharmacy in the Univerfity
of Pennjylvaniay
This DiiTertation
IS RESPECTFULLY INSCRIBED,
BY THEIR MUCH OBLIGED
AND HUMBLE SERVANT,
N. MAGRUDER.
T O
CHARLES A. BEATTY,
Phyfician in George Town in the State of Maryland,
This Inaugural Diflertatiori
IS, ALSO, RESPECTFULLY INSCRIBED,
BY HIS MUCH OBLIGED FRIEND
AND HUMBLE SERVANT,
N. MAGRUDER.
T O
ELISHA C. DICK, M. B.
OF ALEXANDRIA IN THF
STATE OF VIRGINIA.
Worthy Sir,
IMPRESSED with a grateful fenfe of
the favors which you have conferred upon me
in the courfe of my medical Jludy under your
direction, I embrace, with pleafure, this
opportunity of publicly acknowledging your
friendfhip, and that I have derived from you
confiderable improvement in medicine: Be
pleafed, therefore, to accept of this tefimony
of my thanks; and permit me to dedicate to
you this Inaugural Diflertation.
Believe me to he,
SIR,
With the greatefl fncerity,
Tour much obliged Friend and Pupil\
K MAGRUDER.
A N
INAUGURAL DISSERTATION
ON THE
SMALL-POX.
Shewing the mojl proper feafon of the year for
inoculation; the preparations neceffary for fecur-
ing a favorable termination of the difeafe at
each feafon; and the particular difiindions in
the difeafe, for illujlrating a proper adminijira-
tion of remedies.
IN treating of this difeafe, I ihall, in the firft
place, confider the raoft proper feafon of the
year for receiving it, by mewing the difpofitions
to difeafe, which are produced in the human con-
ftitution, from the varied influence of the feveral
feafons; and fome of the epidemics peculiar to
each of them.
The agreeable viciffitude, by which an inter-
mediate moderate feafon is always placed between
the cold of winter, and the heat of fummer, is
a means, which Nature has inftituted, to guard
the human body againfl the difeafes, to which it
would be expofed, if it were not thus, gradually,
prepared for the fucceeding extreme.
But
( 6 )
But the admirable arrangement, by which each
feafon is blended with the preceding one, and,
then, by almoft imperceptible degrees, aflumes
the nature of that which follows it, although, it
certainly prevents, in a great meafure, the de-
finitive effe&s, which a fudden change from
winter to fummer, and from fummer to winter,
would have on the human conftitution, does not
entirely hinder the feafons, as they fucceed each
other, from producing changes in our bodies,
which difpofe them to particular difeafes: This is
evident from the nature of the epidemics peculiar
to the different feafons; which are more regular
in many other countries, than in the variable and
uncertain climate of this, and its neighbouring
flates.
Cold is found, by univerfal experience, to give
a difpofition to inflammatory diforders, and heat
to thofe which are generally called nervous.
During the winter and fpring, pleurifies, peri-
pneumonies, inflammatory angina's, rheumatifras,
and inflammatory fevers, prevail. Towards the
end of fummer, and, particularly, in autumn,
fevers of a different nature, dyfenteries, and
putrid ulcerous fore-throats make their appear-
ance.
June, in my opinion, is the moft healthy month
in the whole year; which is evident from the cir-
cumftance, that there is no epidemic peculiar to
it; and as the weather of it has no power to dif-
pofe the fyftem to any particular kind of difeafes;
the conftitution is, of courfe, exempted, during
the period of that month, from the predifpofing
power of any preceding feafon operating upon
it j and, as May and July vary but little from it,
I confider, thefe three months as the moft healthy
feafon
( 7 )
feafon of the year. And this opinion, drawn
from aftual obfervation, will, unqueftionably,
derive additional force from the remark, that the
weather of thefe three months is, of all other
months of the year, the moft fteady and unchange-
able; and, on that account, fuitably adapted to
the production of good health. And hence I
infer that it is the moft proper time for inocula-
tion.
I conceive that fome phyficians have been
hitherto deceived in preparing their patients by
the ufe of the cold regimen, which, inftead of
extirpating any predifpofition in the fyftem, to a
difeafe, has laid a foundation for rendering the
attack of the fmall pox more fevere; and, by
the imaginary efficacy of this regimen, the cold
feafons of winter and fpring have been preferred
to the more invariable and temperate weather of
the three months before mentioned. In my opi-
nion, the firft fummer month is a time when the
excitement and excitability of the fyftem keep
pace with each other, and reft in an intermediate
and healthy ftate, between inflammatory difeafes,
and thofe of debility. But it is univerfally allow-
ed, that in proportion as we approach to the end
of Autumn the more the fyftem is difpofed to
difeafes of debility; and on the other hand, in
proportion as the fpting approaches fo is the fyftem
difpofed to difeafes of an inflammatory nature.
This predifpofition in the fyftem, whether pro-
duced by feafon, or any other canfe, I confider,
only as a difeafe, in its latent ftate; the nature of
which is determined by the nature of the predif-
pofition a£ted on by the exciting caufe: For in-
ftance, the virus of the fmall pox, when taken
into the fyftem, is, by its fpecific power, an ex-
( 8 )
citing caufe of the difeafe that follows; and in the
degree or proportion that this predifpofition is
allied to difeafes of the fthenic, or afthenic nature,
fo is the nature of the fmall pox determined.
But when it is taken by inoculation, a violent
difeafe may almoft always be obviated, either, by
the choice of a healthy feafon, or a preparative
courfe fuitable to the nature of the feafon or pre-
difpofition in the fyftem; and this I fhall now pro-
ceed to confider: But as inoculation is generally
performed previoufly to the adoption of a prepa-
rative regimen, I fhall firft make a few remarks
upon that operation.
The methods of communicating the fmall pox
have been different in different ages, as well as in
the prefent; but I conceive the moft eligible one
is to immerfe the point of a fharp lancet in the
contagious matter; and, introduce it under the
fkin, in the left arm, by making a fmall oblique
punfture, with the fide, or broad part of the
lancet, next to the fkin, fo as juft to caufe the
appearance of blood; then rub the lancet on and
in the direftion of the puncture, and afterwards
prefs on it, with the blade of the lancet, with the
intention to clofe it, which in fome raeafure pre-
vents the difcharge of blood, that probably might
warn out the infection. I have preferred the left
arm for this purpofe, becaufe it is generally leaft
ufed, and if it fhould be attacked with inflamma-
tion, would be attended with lefs inconvenience
than the right arm, or almoft any other part of the
body. Matter, dried on fmall pieces of glafs, or
poliflied ivory, and, defended againft heat and
moifture, by being inclofed in an ivory box, or a
common fnuff box, is the moft convenient way of
keeping it, and may, in this manner, be preferv-
( <> )
ed for a confiderable length of time fit for ufe*
When wanted for the purpofe of inoculation it
may be moiftened with a little cold water.
Having made thefe remarks I proceed, as I pro-
pofed, to confider the preparative courfe before
mentioned, and the precautions neceffary to be
obferved from the time of inoculation until the
approach of the fever of the fmall pox.—And
with regard to this the patient fhould avoid all the
predifpofing caufes of fever.
Different medical writers have given the public
a lift of the remote caufes of fever, in which is
included almoft every thing that can diforder the
human body, viz. full diet, thin watery diet, too
great exercife, drinking cold watery liquors when
the body is hot, and fpirituous liquors whether the
body be hot or cold, plethora, hemorrhages,
flopping of iffues, and other evacuations, the
retention of excrementitious or other offenfive
matter in the ftomach and bowels, cold dry winds,
moift weather, change of climate, night-watching,
intenfe thought, venery, fear, grief, anxiety, the
miafmata or certain particles floating in the air,
and which arife from marfhy grounds a£led upon
by heat, and the effluvia that flows from living
human bodies pent up or confined from being
diffufed in the atmofphere.
But, it is evident, that the greateft number of
them may be called predifpofing caufes, from hav-
ing only a tendency to predifpofe the body, to be
more powerfully affe&ed by fome fucceeding dif-
eafe; fuch, for example, as the fmall pox. And
this difeafe may be rendered more violent, by the
predifpofing caufes above enumerated. I fhall
confider only a few of them, but the greateft part
may be, naturally enough, included under the ob-
servations which I fhall now make.
In tracing the annals of medicine we find that
many doclrines, which were once fupported by '
B men
( io )
men of the higheft medical authority, are now
exploded and proved to be erroneous; with fuch
examples before me, whatever may be the deter-
mination of the multitude, I think I may, here,
without cenfure, exprefs the conviction of my
own opinion, that the practice of the cold regimen
as it now prevails, and has obtained in this difeafe,
is grounded upon erroneous doctrine. It may
ferve to elucidate this opinion to obferve, that
when the fmall pox made its firfl appearance, the
hot regimen, was, I believe, universally praclifed.
Experience, however, and philosophical inveftiga-
tions of truth, afterwards difcovercd this plan of
treatment to be pregnant with the moft deleterious
effects; and. with reafon, dictated adifferent remedy.
This remedy was then fought for in a dire&ly
oppofite extreme. The cold regimen was adopted,
in all its unlimited extent, not only in the difeafe
itfelf, but. even during the preparative courfe.
Here the common adage, that one extreme begets
another, was remarkably exemplified—For my
part I am of opinion that either extreme is equally
improper in preparing a patient for this difeafe;
and I fhall treat of them Separately as it will lead
to explain the advantage of a particular and healthy
feafon, and the preparation neceffary for each
different feafon of the year, and
Firfl, From heat predifpofing the fyftem to be
affected with a fever of debility and the confluent
fmall pox in a direct manner.
Secondly, From cold predifpofing the fyftem to
be affected with a violent inflammatory fever and
the confluent fmall pox in an indirect manner.
The firft may be explained by the heat of fum-
mer, when gradually and uniformly applied, hav-
ing a conftant tendency to relax and debilitate the
human conftitution; this appears evident when
we obferve, that the inhabitants of warm climates
are generally more effeminate and lefs capable of
great
( 11 )
great exertions than thofe of the moderate and
colder; and we alfo find that the common difeafes
of warm climates are the reverfe of inflamma-
tory. But in our own climate when the heat of
fummer acts gradually on the body, there can be
no doubt but that it tends to remove from the con-
ftitution the inflammatory difpofition produced by
the cold of the preceeding feafon, and difpofes
to difeafes of a contrary nature; and the nearer
the end of autumn approaches, the more this dif-
pofition is increafed, in fome conftitutions than in
others. And if we fhould unfortunately be forced
to inoculate at this feafon, we fhould not only
keep the patient out of the fun, and moderately
cool; but, in debilitated conftitutions. give tonics,
of which the Peruvian bark is the beft, and a
generous nourifhing diet, to obliterate the predif-
pofing debility and bring the conftitution to a
more healthy ftate, which undoubtedly will render
the difeafe milder. The patient fhould avoid fti-
mulating aliment, fuch as roafted, fried, and fak-
ed meats, alternate and fudden changes from heat
to cold, and fpirituous liquors. Lenient purges
fhould be given to prevent too great an accumu-
lation of excrementitious matter in the inteftinej.
There is no doubt but that autumn difpofes the
body to difeafes attended very often with diforders
in the flomach, and bowels, and the appearance
of a redundancy or acrimonious ftate of the bile;
from this circumftance I infer that in preparing a
patient at this feafon of the year, gentle emetics
may fometimes, be very ufeful.
The fecond part of my propofition may be ex-
plained by obferving, that the inhabitants of cold
climates are more robufl, and capable of greater
exertions, than thofe ofwarmclimates; and alfo thofe
of our own climate, in confequence of the operation
of cold weather, and the gradual approach of fpring,
increafing the difpofition in the fyftem to inflamma-
tory
( I* )
tory difeafes. The preparation of a patient, for the
fmall pox at this feafon, mull, of courfe, be effenti-
ally different from that fuited to the autumnal fea-
fon; for, adebilitating plan is, at this tinle,indifpen-
fably neceffary to abate and eradicate the inflam-
matory diathefis. This intention may be fully
anfwered by the exhibition of purgative medicines
or by blood-letting. The liberal or parfimonious
ufe of thefe remedies ought, however, to be
dictated by the predominant fymptoms and practiced
according to the ftrength and conftitution of the
patient. Expofure to extreme cold, and alternate
changes from heat to cold, and cold to heat, fhould
be avoided. The patient fhould alfo abftain from
invigorating and ftimulating aliment, and ufe a
light vegetable diet.
But, by inoculating in either of the three months
before mentioned, the trouble in a great meafure
both to the phyfician and patient, of the ufe of
an invigorating courfe of preparation in the fall,
or the debilitating one in the fpring is avoided.
And from what has been faid, the reafon of my
opinion, that the month of May, June or July,
is the moft proper time for inoculation, is fuffici-
ently plain; for, I conceive it would be an act of
fupererogation to demonflrate the abfolute necef-
fity of avoiding the predifpofing caufes of fever.
If the health of the patient fhould have been pre-
vioufly interrupted by any difeafe, he fhould, in
that cafe, be prepared for the fmall pox by medi-
cines fuitable for the cure of the previous difeafe.
And as the temperature of the weather, in May,
does not reduce the condition of the body to a
healthy point, and as that of July reduces it be-
low it, the conftitution, in general, requires,
that the preparation in the former month fhould
partake in fome meafure of that neceffary for the
fpring; and in the latter, of that fuited to autumn.
Attention fhould, however, always be paid, to
the
C 13 )
the conftitution of the patient and the epidemic
prevailing at the time of inoculation; for, diffe-
rent conftitutions, and other attendant circum-
flances, require a different preparative treatment,
for the fame reafon that the fevers of the diftindt
and confluent fmall pox require different remedies;
and it is upon this ground of practice that the
mildnefs of the difeafe very materially depends.
I have often had occafion to obferve, that fome
phyficians have inoculated one part of a family,
and poftponed the inoculating of the other, until
juft before the former had taken the fever. Rea-
foning upon this fact from the principles of ana-
logy, which hold good in all other contagious
difeafes, and which apply with equal force to the
contagion of the fmall pox, I have been hence led
to infer this conclufion, that the continual appli-
cation of the contagion or remote caufe of the
difeafe, I now contemplate, arifing from thofe of
a part of a family firft inoculated, to thofe of it
who are poftponed, as before mentioned, until
they are attacked, is an injurious practice and
mull, unqueftionably, in a great degree, with
refpedt to that part of the family fo poftponed,
fruftrate all reasonable hopes of the mildnefs of
their impending difeafe.
Before I leave this part of my Subject, I muft
obferve, that the intention which has influenced
phyficians, whilil preparing a patient, to recom-
mend the ufe of a repeated and almoft continual
application of local bathing, with cold water, to
the eyes and the part inoculated, to prevent
inflammation, is always defeated. Though cold
bathing will cure ophthalmia, and diminifh inflam-
mation in the place-inoculated, yet, when ufed as
a preventative, it will render the parts more fuf-
ceptible of it; and for this reafon, becaufe the
fyftem is difpofed to local inflammations from an
cxpofure to, or a partial application of, cold.
I come
( 14 )
I come now to the treatment proper for the dif-
eafe itfelf.
There is no doubt, but that the cold of winter,
when gradually applied, tends to increafe the
inflammatory difpofition in the body, and the heat
of fummer, applied in like manner, tends to re-
move it; but in what particular manner, thefe
effects are produced, is a fubject too abftruce
for me to determine. I fhall reft in the know-
ledge of the facts, that, in the fall, the body
appears to be relaxed and much debilitated; and
that the heat of fummer, when gradually applied,
has a power of relaxing and diminifhing, and cold
the power of increafing, the tone in the folids of
the fyftem. Thefe are incontrovertible facts, and
will remain inconteftible whilft the excitability of
the fyftem, to be acted on by flimuli at every
feafon, continues the fame; but without making
againft this principle, an exception may be admitted
in favor of an increafe or diminution of the ex-
citability, in a degree proportioned to the quan-
tity of flimuli acting upon it. Nor is it lefs indu-
bitable, that the continued and regular operation
of a certain quantity of them is neceffary for life
and health. But this principle in the animal
oeconomy, can only receive the impreflions of a
certain quantity of flimuli, which are different
accordingly as their application is fudden or gra-
dual. And we alfo know, that the force of action,
produced by flimuli, depends on the tone in the
folids of the fyftem; and a certain degree of tone
in them is neceffary for health.
This, and the univerfal fact, that two equal
impreflions of a contrary nature do not act by
each producing its feparate effects on the fyftem
at the fame time, lead me to hazard an opinion,
that the caufes that produce moft difeafes depend
on a certain ftate or tone in the folids, connected
with a certain portion of ftimulability in the fyftem,
or
( >5 )
or a certain condition of them in the conftitution of
the individual, to favor the action of an exciting
caufe, and render him fufceptible of a difeafe;
without which, how much foever he may be ex-
pofed to an exciting caufe, he will not, at that
time, be Seized with a difeafe: If this be true,
we may conclude, that all difeafes take their ori-
gin in the folids and not in the fluids; and thus
the various changes of the fluids in difeafes, are
only in confequence of, or a fymptom depending
upon a certain condition or difeafe in the folids.
If thefe conjectures be true, the antient doc-
trine, fo long reputed orthodox, and fo long a
Subject of controverfy amongft phyficians, " That
a fever is an effort of nature to change or con-
coct fome noxious or morbid matter that is in the
conftitution, So that it fhall either be rendered
quite innocent or thrown out of the body," muft
lofe that diftinguifhed claim to confideration which
it was thought to deferve; and be contemplated
only as an ingenious theoretical difquifition, con-
tradicted, however, by the reafon of practical
facts. The advocates of this doctrine fay, that
the fmall pox is the effect of a morbific matter,
of a fpecific kind, received into the body, and
where an eruption takes place in confequence of
the fever, which not only deprives the body of
the power of ever again receiving it, but clears
the conftitution of the noxious matter introduced;
and hence arofe the opinion and improper practice
of giving ftimulating medicines, according to the
common phrafe, to force out the pock, which, in
my opinion, where fuch medicines were given,
with that intention, often proved an injury. Bu:
later experience has proved, that an eruption is
not neceffary to infure the patient againft a future
attack; but that the fever obtunds certain fenfa-
tions of impreffion in the fyftem, which renders
it ever afterwards infenfible to the difeafe. But,
however,
( I<5 )
however, an eruption may ferve as a criterion by
which we can judge of the identity of the difeafe,
and as a confolation to human nature by furnifhing
the pleafing conviction of being hereafter freed
from its infidious attack, and all its attendant
anxieties.
The great Doctor Cullen defines the fmall pox
to be a difeafe arifing from contagion of a fpecific
nature, which firft produces a fever, and on the
third or fourth day thereof, produces an eruption
of fmall red pimples. Thefe are afterwards formed
into puftules, containing a matter, which, in the
courfe of eight days from the time of the erup-
tion, is changed into pus. After this the matter
dries, and falls off in crufts.
In naming this illuftrious author, cs * before
whom death himfelf appeared frequently to drop
his commiffion in a combat with his fkill"—I paufe
to contemplate his fuper eminent merit.—To this
luminary of medical fcience, we are indebted, in
a great degree, for the prefent improved ftate of
phyfick! I fhall adapt his definition, and as my
knowledge and obfervation will not permit me to
add to the accuracy of the hiftory of this difeafe,
given by this celebrated author; and as I take it
for granted that all medical gentlemen poffefs his
works, I muft refer them to his firft linesf for an
accurate hiftory of the fmall pox.
This difeafe comes on with a fever as before
mentioned, but of a different nature in different
patients; that is to fay, it approaches more or
lefs to that of an inflammatory or typhoid appear-
ance. And this fever will accordingly require a
different treatment in proportion as it affumes an
inflammatory or typhoid nature, which, I fhall go
on to treat of fucceffively. But in confequence of
inoculation, and proper a management of the
patient,
* Vide Doflor Rufh's Eulogium on Dottor Cullen.
f Vide Doctor Cullen's firft lines of the practice of phyfic,
( i7 )
patient, it almoft always appears in a mild inflam-
matory form, which I fhall firft confider.
The inflammatory fpecies of this difeafe comes
on generally with all the Symptoms of inflamma-
tory fever, in a greater or leffer degree. And
when the difeafe is violent, it is frequently accom-
panied, be fides a full hard pulfe and third, with
a fevere pain in the head and back; a fulnefs in
the lungs; frequent inclinations to fleep, with a
fudden ftarting when the patient is juft ready to
fall a fleep, or has actually gone to fleep, which
immediately awakes him; great heat preceded
by a fe fation of coldnefs, and frequent chills.
The obvious indications of relief here, are to
abate the too violent action of the heart, which
gives rife to all the other fymptoms; and nothing
has been difcovered fir.ee the earlieft medical
records, which fo effectually gives relief in all
difeafes where the blood is too impetuoufly pro-
pelled, as diminifhing its quantity. In doing this,
great attention muft be paid to the degree of vio-
lence of the difeafe, the fex, age, conftitution
and occupation* of the patient. The repetition of
bleeding fhould be determined by the continuance
of the fymptoms and the appearance of the blood.
After diminifhing the quantity of blood, the
remedy which has the moft immediate tendency to
give relief in this fpecies of the difeafe, is to
evacuate the inteflinal canal; and, therefore, it
is highly expedient, foon after bleeding, to give
fuch a purgative as will effectually empty the
whole courfe of them, and remove the irritating
power that arifes from an accumulation of their
excrementitioas contents, without occafioning
griping; or, otherwife, ftimulating the fyftem;
and the propereft for anfwering this intention' are
C thofe
* Vide Doctor Currie's hiftorical account of the climate
and difeafes of the United Sttates of America . Page 42.
( >8 )
thofe of a cooling nature, and of fuch the mate-
ria medica iurnifhes an ample variety. They alfo
drain the arteries and other veffels which pour
their excretions into the cavity of the inteftines,
and, by this evacuation, diminifh the too violent
contractions of the heart and impetuofitv of the
circulation; or, in other words, abate the fever.
Collivenefs fhould be obviated through the whole
courfe of the difeaSe, by medicine Suitable for
that purpofe.
There is a certain refrigerant, which is fo ob-
vious in giving relief to thofe who fuffer from the
heat of fever, that nothing can prevent it from
being univerfally adopted. I have before endea-
voured to explain the impropriety of the cold
regimen while preparing a patient, but here the
obvious advantage, that may arife from it, can
be better experienced than defcribed. However,
the application of cold fhould always be uniform
and conflcint.
The quantum of cold, as well as of bleeding
and purging, fhould be regulated in proportion
to the violence of the fever, leaft a too free ufe
of them might fuddenly change the nature of the
difeafe, to that of a typhoid.
Ihe moft important remedies that can check
the career of the inflammatory fpecies of this
difeafe have been mentioned, yet there is no doubt
but that all the good effects, expected from them,
may be promoted by fome of the antimonials, and
neutral falts. as nitre, &c.—To thefe I may add
the mild fubacid drinks, as lemonade, orange or
lemon wheys, barley water, pure water, rafberry
or currant jelly diffolved in water, apple tea,
balm tea acidulated with lemon juice, and other
combinations fuited to the patient's tafte, to abate
the uneafy and irritating fenfation of thrift.
The
( >9 )
The other, or typhoid fpecies of this difeafe,
comes on with laffitude, an irregular fenfation of
cold approaching tochilnefs, a pain in the back,
a confuted pain in the head with delirium; thirft,
naufea, and Sometimes vomiting; thepulfe, though
hard and quick, yet is not So Strong, full, and equal,
as in the inflammatory fpecies, neither is the heat of
the body fo great, nor does it come on fo fuddenly.
This fpecies appears to be of a mixed nuure,
and to reft in an intermediate ftate between fyno-
cha and typhus, and which may be called a con-
necting link between thofe two fevers. This I
infer to be the cafe, by the fymptoms before men-
tioned, forbidding the ufe of flimulants. by its
perfidious nature, after difplaying a likenefs to the
former, is apt fuddenly to affume the appearance
of the latter, and by a moderate bleeding inftead
of producing the good effects which we might
probably expect, not unfrequently occafions a
fudden and dangerous degree of weaknefs.
If it be difficult to point out a regular plan of
treatment in difeafes whofe indications are more
uniform, it muft be ftill more difficult in this fpe-
cies of fever, whofe middle nature announces it
to be a difeafe both of the arterial and nervous
fyftem. And as debilitating remedies are benefi-
cial in difeafes of the arterial fyftem and hurtful
in the nervous, one of the moft important points
is to decide on a plan of treatment proper for this
fpecies of the fmall pox. Here I muft coincide
with what Doctor Rufh obferved in his laft courfe
of lectures, on this fpecies of difeafes, in repeat-
ing, that the beft we can do, is to do nothing at
all, but watch the change that is apt fuddenly to
take place; to this I will add the alleviation of
certain fymptoms, which would aggravate the
difeafe.
If we have reafon to think, that there is an
accumulation of acrimonious matter in the ali-
mentary
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mentary canal, it follows, of courfe, that fuch
an accumulation muft aggravate every Symptom
of the difeafe; and it cannot be doubted that the
throwing of fuch a load out of the body muft
have a confiderable effect in relieving the oppreff-
ed and reftlefs patient. And when there appears
to be a tendency to a new accumulation, which
may be known by the patient's becoming coftive
and reftlefs, he fhould be relieved by clyfters or
the ufe of fuch a mild cathartic as will perform
its office eafily and without griping. However,
the ufe of purgatives may be objected to, from
an apprehenfion of their diminifhing the patient's
Strength; it muft be remembered, that nothing is
more exhaufting than the heat and reftleffnefs oc-
cafioned by an accumulation of acrid faeces and
other matter in the bowels. The purgative,
therefore, which removes thefe, proves, in effect,
to be a Strengthening and not a debilitating reme-
dy; befides, this accumulation is apt to buift
forth in a violent diarrhoea,* which might fud-
denly reduce the patient to a very great degree of
weaknefs, but which may be prevented by a well
timed and judicious ufe of a mild laxative.
It feems obvious, that the alleviation of third
will relieve an uneafy Symptom of this difeafe.
This may be effectually done by drinking the
quenching liquids before mentioned", and ufing
the proper aliment for a feverifh and capricious
flomach, fuch as all forts of mild juicy ripe fruits:
Thefe fpread a refrelhing moifture over the parch-
ed tongue and throat of the languid patient, and
footh the ardor of his thirft; befides which they
have alfo a tendency to keep the bowels open.
With regard to the propriety of the ufe of the
cold regimen in the typhoid fmall pox, It will, I
expect,
* And, in my opinion, the diarhaea that fometimes at-
tends this difeafe, often arifes in this manner.
( *I >
expect, by every unprejudiced mind, be thought
injurious, except as to the meer application of
freffi air, and this is felf-evident effential to the
well doing and recovery of the patient. And
with regard to the propriety of a free ventilation,
it: is beyond all contradiction proved, by obferv-
it-g rhe benefit which arifes from its manifeftly falu-
ta ry effects in other contagious difeafes of debility.
I come now to confider the moft important part
of the treatment for a typhoid fever of the fmall
po x, which is, to watch the change that is apt
fuddenly to take place. And if this fever is left
to itfelf, it not unfrequently approaches more or
lefs before the eruption to a typhus;* which will
afterwards continue to increafe with unrelenting
aff duity, and foon reduce the patient to an irre-
coverable fituation. This typhoid fever never
fails to ufher in a confluent eruption, with more
or lefs malignity, in proportion as it has, at that
time, affumed more or lefs of a typhus nature,
which may be interrupted in its career by a well
timed and judicious ufe of the Peruvian bark.
When this difeafe comes on with a typhoid
fever, as I have before obfervcd, the confluent
fmall
* A typhus is a fever that affects the nervous fyftem;
tbough, indeed, every fever affects it in fome meafure,
beraufe a fever occafions a general disturbance of the whole
ani.mal ceconomy, of which the nervous fyftem is a part;
but .in this particular fever called typhus, the nervous fyftem
is m ^re particularly and violently affefted than in other
fever.'. And it is diftinguifhed by being accompanied with
a proitration of ftrength and debility of the whole fyftem;
the pivfe varies more than in other fevers, both in point ol
quicknt fs and flownefs, and ftrength and weaknefs; the
fkin is generally pale, and gives a penetrating heat to thofe
who touvh the patient; a heavinefs in the head, and tre-
mor in the hands, accompanied with lanquor and defpon-
dency. T4He malignity and danger of this fever is gene-
rallv in proportion to the degree of debility, which import-
tant circunutance ought conftantly to b; kept in remem-
brance.
( •* )
fmall pox is produced in a direct manner, and in
an indirect manner, when the difeafe comes on with
inflammatory fever, which afterwards degenerates
into a typhoid. This opinion is, with me. flill
more confirmed, when I reflect, that all fevers,
after continuing a certain time, without any
favorable change, affumes nearly the fame appear-
ance;* this induces me to fay, that an inflamma-
tory fever firft paffes to a typhoid, after which it
Seldom fails to glide on with an augmenting celerity,
to the confequences of an approaching typhus.
When the confluent fmall pox is produced,
whether in a direct or indirect manner, there is
no diftinction neceffary to be made, as it requires
the fame treatment. The natural fmall pox, in
autumn, feldom fails to attack with a typhcid
fever, which, in my opinion, Sufficiently afcertams
the general utility and great advantage of the
practice of inoculation, for it is conducive to
happinefs in leffoning the miferies of human nature,
not only by affording us the important advantage
of a preparation, but the choice o£ a molt con-
venient time or healthy feafon for taking the difeafe.
The time for adminiftering the Peruvian bark
muft be left entirely to the judicious and prudent
practitioner; but from the perfidious nature of
this difeafe to take a fudden change, the bark had
better be given too foon than too late; and at
any period of the difeafe, if the patient unex-
pectedly becomes giddy, feeble, and languid, we
fhould directly have recourfe to the bark, as a
means to obviate the melancholy train of fymp-
toms, of which a fudden proftration of ftrength
is often the forebodcr; but when, in fpite of ail
our efforts, they have taken place, the difeafe is
no longer of a typhoid kind, but has degenerated
into a true typhus, putrid or malignant.
When
* Vide Doctor Currie's hiftorical account of the climate
and difeafes of the United States of America. Page 122.
( n )
When the fituation of the patient requires the
ufe of bark, the quantity adminiilered muft de-
pend on the virulence of the difeafe; but where
the inflammatory diathefts is entirely obliterated,
the difeafe accompanied with great debility, and
the eruption puts on a very confluent afpect, the
bark may be given from one to tv/o ounces in a
day. Wine, by adding to its good effects, is a very
good menftruum for k to be given in. However,
the ufe of the bar!:, in any fever, may, probably,
be objected to; but for an explanation of its be-
neficial effectc, I muft recommend the reading of
Doctor Cleghorn's obfervations,* who, by prac-
tical tacts, has verified the propriety of its admi-
ni'ftration in fuch cafes.
I fhall conclude the fubject of this differtation,
with fome obfervations on the alleviation of fome
alarming fymptoms, which fcmetimes accompany
the fmall pox.
The convulficns, that fometimes attend this
difeafe, have caufed a great de?.l of doubt with
regard to the remedies proper for their cure;
but, from the univeifal fact, that the cure of all
fymptomatic affections depends on a cure of their
primary difeafe, it manifeftly appears, that the
remedies for thofe convulfions fhould be different,
when they attend the inflammatory or typhoid
fever. If convulfions occur in the imflammatory
fpecies of this difeafe, all the remedies that are
recommended, for that fpecies, are proper to
remove them, particularly expofing the patient to
cold; but if they attend the typhoid, all the re-
medies recommended in that cafe are proper; but
when the nature of this fever appears to ballance
on the fide of debility, liquid laudanum mav be
ufed to alleviate the convulfions, and afford an
opportunity
* Vide Dodlor George Cleghorn's obfervations on the
epidemical dueales of Minorca.
( -24 )
opportunity to adminifter the bark, which is a
more certain and durable remedy.
Another fymptom that fometimes attends this
difeafe, is an inflamed arm; here f confider rnld
bathing to be the moft certain reffiedy5 but igno-
rance and the ufurping opinions of fome people,
have brought it too generally into ufe; of this I
am convinced, from facts that occurred to me
during the laft fummer, when fome, after their arms
became fore, made too liberal a ufe of local bach-
ing of cold water. The confequence was, the
inflammation began to vanilh, and, at length, their
ulfers put on a gangrenous appearance, for which
they were obliged to have recourfe to ftimulating
applications, to produce the neceffary degree of
inflammation for their healing, and for which
purpofe powdered bark, made moift with water,
was very efficatious. If the eyes fhould appear
inflamed, cold bathing* of them may be ufed,
with advantage, and almoft a certainty of reieav-
ing the inflammation, and preventing the appear-
ance of pock. Although what I have now faid
of the ufe of this powerful remedy, may appear
paradoxical, when compared with what I have
faid before, I fhall reft fatisfied in the hope, that,
through the courfe of my differtation, I have
fufficiently inveftigated and reconciled the diftinc-
tions neceffary for its ufe.
* The effefts of cold water may be increafed by adding
fome of the faturnine preparations to it.
FINIS.
no
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